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The Study in Etiology of Atrial Fibrillation

Atrial fibrillation （AF） as a most frequent arrhythmia has a high incidence of 79% in patients with mitral valve disease. Thrombosis, embolization and serious arrhythmia can be caused by AF. There is the recrudescent tendency in using drugs to recover the sinus rhythm, surgery and radio frequency ablation can only cure a part of patients. By now the pathogenesis of AF is not known clearly. The pathogenesis of AF from virulence gene, cardiac electrophysiology, connecxins, cell ultramicrostructure and cell signaling system are reviewed in this article.

腰大池引流腦脊液治療主動脈夾層術后截癱六例

面罩無創通氣在胸心血管外科的臨床應用

目的探討面罩無創通氣在胸心血管外科的臨床應用效果。方法20例心血管、肺、食管疾病患者行手術治療，術后拔除氣管內插管后發生呼吸衰竭，于拔除氣管內插管1～39h實施了面罩無創通氣，觀察通氣前、通氣中以及撤離面罩后的呼吸相關生理參數變化。結果患者經面罩無創通氣后的呼吸相關生理參數與通氣前比較有明顯好轉（P〈0．01）。結論面罩無創通氣能有效改善患者的呼吸狀態，促進呼吸、循環系統功能的恢復。

雙瓣膜置換術后長Q—T間期綜合征并發尖端扭轉型室性心動過速一例

Analysis of Risk Factors for Death in Patients Undergoing Continuous Renal Replacement Therapy after On-pump Cardiovascular Surgery

ObjectiveTo retrospectively evaluate the risk factors of mortality in postoperative acute kidney injury (AKI) patients undergoing continuous renal replacement therapy (CRRT) after cardiopulmonary bypass (CPB). MethodsWe retrospectively analyzed the clinical data of 66 patients (38 males and 28 females with mean age of 59.11±12.62 years) underwent CRRT after cardiovascular surgery in our hospital between May 2009 and June 2014. The patients were divided into a survival group (18 patients) and a death group (48 patients) according to treatment outcome at discharge. Univariate analysis for risk factors of death was carried out for preoperative characteristics and lab results among study population. Significant univariate factors were then further analyzed by multivariable logistic regression models. ResultsSignificant predictors of death included blood transfusion volume during operation, peak level of blood sugar and lactate during operation, the total bilirubin level and platelet count on the first day after operation, hypotension on the first day after operation, pulmonary infection, multiple organ dysfunction syndrome (MODS) and the interval time of oliguria and CRRT (P<0.05). Logistic regression showed that there were statistical differencs in hypotension on the first day after operation, postoperative platelet count, and interval time of oliguria and CRRT respectively (P<0.05). ConclusionImproving intraoperative management, reducing bleeding and blood transfusion, controlling blood sugar level, dealing with complications such as hypotension, pulmonary infection and MODS more aggressively, starting CRRT when needed may be helpful to reduce mortality. Monitoring of the blood pressure and platelet count on the first day after operation is useful for prognosis estimation.

床旁肺部超聲評估對心臟術后早期肺實變和肺不張的診斷準確性研究Accuracy of bedside lung ultrasonography in diagnosis of pulmonary consolidation and atelectasis in postoperative cardiac surgery patients

目的 探討床旁肺部超聲對心臟術后早期肺實變和肺不張的診斷準確性。 方法 選取 2014 年 9 月至 2015 年 8 月四川大學華西醫院心臟大血管外科行心臟大血管手術（包括冠狀動脈旁路移植術、瓣膜置換術等）后 1 周之內出現呼吸衰竭的 49 例患者，其中男 24 例、女 25 例，年齡（54.4±13.2）歲。收集患者術后床旁肺部超聲及胸部 CT 檢查結果，進行對照、分析、總結。 結果 在肺實變和肺不張的診斷中，胸部 CT 診斷 47 例（95.9%）患者為陽性，肺部超聲評估方案（BLUE方案）診斷 45 例（91.8%）患者為陽性，床旁肺部超聲與胸部 CT 診斷一致率為 95.9%。 結論 床旁肺部超聲可作為篩查肺實變和肺不張的方法。